Organization
ELK GROVE RADIOLOGY S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN KONDAS (OFFICER)
(954) 838-2371
Entity
Organization
Contact information
Practice address
800 BIESTERFIELD RD, ELK GROVE VILLAGE, IL 60007
(847) 437-5500
(847) 952-7912
Mailing address
800 BIESTERFIELD RD, ELK GROVE VILLAGE, IL 60007
(954) 838-2371
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1635109
BLUE SHIELD OF ILLINOIS
IL
01
—
DD3120
RAILROAD MEDICARE
IL
Enumeration date
10/04/2006
Last updated
08/21/2019
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